HomeMy WebLinkAboutHomestead_Elpers (32) STATE FORM 53569(R3t5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FLVANCE IC6-1.1-22-S.I
IMPORTANT NOTICE TO HOMESTEAD PROPERTY-OWNERS A
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
gs uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead •
ndard deduction to verify thatythey'are eligible to receive the benefit and to provide additional identifying
,information necessary to allow county government to bettermonitor homestead filings. This information
: will be kept confidential and can onlYbe accessed by authorized county officials. The Department of Local
Government-Finance will use'this inforniation to create tools that will help county officials eliminate
•
homestead fraud.
PAR 1: PROPE' Y INFO•MATION
Taxpayer Name Property Address State Parcel Number Legal Description:
Urban D Elpers 4752 E 1200 S 26-23-13-100-001.397-024 w NW 13 4 10 1 AC
HAUBSTADT IN 47639 o-9
Complete and return to: I®IIIMEMO�V00UMIDOImIIDHlUmmlmfm®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 NJ LLI LLII [I!
Omer 1 First Middle Last
Staffing Address(number and steel oty.state and ZIP Code) I I
✓2a^'e as property address
41-7SZ' / loos /IAu$s94d* /)J 417639
- First - Middle , . Last
�4k ivAl— Njte
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Mating Address(number and steel city,state and ZIP code) Same as property address
Social Security Nunter(last 5 digits) Odve's license/State ID Number(last 5 digits) sue Other(please specify in Pan 4 below)
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to receive the
homestead standard deduction on this property.Each undersigned also understands that,by claiming additional homestead deductions unlawfully,he or
she may be liable for back taxes and substantial financial penalties.
Owner 1 Signature Date
( )
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' PART 4: ADllITIO\AL INFORMATION
FILED ._.
1111 NOV Fan
bIbSON COUNTY AunITOR
wnrn nc io �e�v
; Preuri�ed By State BwrE of Tan Cammissioners
CLAIM FOR HOMESTEAD PAOPERTY TAX CREOIT FOR YEAR 19�L
To & FIW in Duplicate
SEE BACK FOR FILING INSTRUCTIONS �U'a�T'���17`��
�
��yye�l���� ��no�.�� certify that on the 1st day of
arch, 19$�, I, (We) occupie as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) fd'owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description i
Taxing District (City, Town, Township):
Parcel Number
If buying Ofl contract: Owners name ��� simo�e owner)
ca�� 0?3 /3-/00-60/�p�G�`�
nty
Township
or legal description shown on tax statement:
r �
l�/�2 �tiG.� �/3 -�- io l Ae .
Contract recorded in Recorders Office - Record No. Page
Ii any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
str�i�s��duce income, describe the use and portion of the property utilized to produce income
Any o{l�t� Ati � which individual owns or is buying real property: County Township
yy��r, �1
ereby ��herlabove statement is true, correct and complete.
�
'Si nature Sneet Aaaress �
Zi0 CoOe
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneticial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residentia� Improvements
Dwelling
Garage
Total
(1)
(2)
(3)
(4)
(5)
(s)
True Cash
Value
Other Improvements (�l
T Improvements - Line (6) plus (7) equals (8) (8)
1 ;by certify the above is true. correct. and complete.
Sigeuwre ol Assesmr
' �j � , `„ - ACTION BY AUDITOR -
G���L,� y��. . ., �
Assessed
Valuation
Da�e
Homestead
Valuation
Date: =!�9— A;9